18 OPINION
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18 OPINION
8 MARCH 2024 ausdoc . com . au
The next big thing ? Let allied health refer directly to specialists
PAGE 16 homoeopathic products due to their lack of reliable evidence of efficacy .
That ’ s a bit like the Royal Australian and New Zealand College of Psychiatrists telling its members to ditch the mysterious diagnostic wonders of phrenology .
Chiropractors were not even listed , despite its fringe elements dabbling in antivax nonsense and practices rooted in a pseudoscience version of human biology .
So when it comes to the scope of practice review , why does it fail to acknowledge the risks given opening up referral pathways is a recipe for too much care .
We are not talking about abstractions .
In 2018 , restrictions were added to MBS items for chiropractors to request their own X-rays because they were being ordered for assessment of lower back pain .
The restrictions were one of the early recommendations
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by the MBS Review Taskforce who flagged both the cost to Medicare and the damage of unnecessary irradiation of patients .
In consumer land , the fixes to GP shortages are simple .
GPs as the mechanism to specialist access under the MBS was a policy recognition of what can go wrong in the absence of doctors with specialist training in the business of undifferentiated diagnosis .
It is not an accident , some historical quirk that emerged while no-one was looking .
And despite suggestions to the contrary made in the issues paper , fragmentation of care and the chaos that can ensue is not fixed by allied health practitioners
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The deeper issue is bound up in the issues paper ’ s constant repetition of that word “ consumer ”.
If you see patients as consumers , then you see them as people who are essentially buying goods and services . If you have that mindset in the context of health reform , you start thinking its principle objective is
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once daily 1 removing barriers to those goods and services .
So the current GP crisis — whether seen as a workforce crisis or a bulk-billing one — becomes a healthcare branding battle , where you fill the shortage of GP goods and services by opening up the market to other “ retailers ”.
Queensland ’ s embrace of pharmacy prescribing for UTIs has been a classic example of this mindset made real .
A patient needs antibiotics ? Can ’ t see a GP ? Let the pharmacist sell them , with the job of accurately identifying clinical need , while not totally irrelevant , deemed secondary .
The patient wants access to a specialist or diagnostic tests ? GPs not bulk-billing ? Someone else can stand in .
GP care at its best is anti-consumerist in the sense that it deliberately reduces unnecessary healthcare consumption .
There is a reason why the ‘ prescribe and refer ’ model of general practice is used as an insult within the specialty .
But the worldview of so many policymakers ( and pollies ) seems infected with the patient-as-consumer in ways that are undermining their capacity to think clearly about what it is that GPs are doing in the health system .
Perhaps the final report will be more verbal air bubbles .
Training and attracting more doctors to the specialty is not easy . Bringing in IMGs as a substitute is vexed . And no government has shown any genuine interest in investing in general practice given the photo opportunities of new hospitals as elections loom .
But in consumer land , the fixes do become simple , but only in the empty language used to describe them , as illustrated by the intellectual poverty of Professor Cormack ’ s issues paper .
His review is meant to be delivering a draft report sometime before September .
Given the complexity of establishing scope of practice even in the narrowest of clinical areas in ways that both protect and benefit patients ( yes , I ’ m thinking of pharmacist UTI diagnosis ), it ’ s hard to see anything substantive will emerge .
Perhaps the final report will be more verbal air bubbles about future worlds .
There will be many who hope that proves true .
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